Recovery from Anesthesia after Robotic-Assisted Radical Cystectomy: Two Different Reversals of Neuromuscular Blockade

Abstract

During robot-assisted radical cystectomy (RARC), specific surgical conditions (a steep Trendelenburg position, prolonged pneumoperitoneum, effective myoresolution until the final stages of surgery) can seriously impair the outcomes. The aim of the study was to evaluate the incidence of postoperative nausea and vomiting (PONV) and ileus and the quality of cognitive function at the awakening in two groups of patients undergoing different reversals. In this randomized trial, patients that were American Society of Anesthesiologists physical status (ASA) ≤III candidates for RARC for bladder cancer were randomized into two groups: In the sugammadex (S) group, patients received 2 mg/kg of sugammadex as reversal of neuromuscolar blockade; in the neostigmine (N) group, antagonization was obtained with neostigmine 0.04 mg/kg + atropine 0.02 mg/kg. PONV was evaluated at 30 min, 6 and 24 h after anesthesia. Postoperative cognitive functions and time to resumption of intestinal transit were also investigated. A total of 109 patients were analyzed (54 in the S group and 55 in the N group). The incidence of early PONV was lower in the S group but not statistically significant (S group 25.9% vs. N group 29%; p = 0.711). The Mini-Mental State test mean value was higher in the S group vs. the N group (1 h after surgery: 29.3 (29; 30) vs. 27.6 (27; 30), p = 0.007; 4 h after surgery: 29.5 (30; 30) vs. 28.4 (28; 30), p = 0.05). We did not observe a significant decrease of the PONV after sugammadex administration versus neostigmine use. The Mini-Mental State test mean value was greater in the S group.

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…S15, http://links.lww.com/ALN/C929). 66,82,99,102–104 A pooled estimate from seven nonrandomized studies also did not detect a difference in pulmonary complications (very low strength of evidence). 45,93,105–109 Five randomized controlled trials 59,61,66,104,110 and four cohort studies 93,106,108,109 reported fewer episodes of pneumonia with sugammadex than neostigmine (low to very low strength of evidence; supplemental fig.…”

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,92,95,[98][99][100][101][102][103][104][110][111][112][113][114][118][119][120][121][122][123][124][125][126][127][132][133][134][135][136][137][138][139][140][141][145][146][147][148][155][156][157]163,[173][174][175][176][177][178][179][180][181] 11 nonrandomized trials, …”

Potential Neuroprotective Role of Sugammadex: A Clinical Study on Cognitive Function Assessment in an Enhanced Recovery After Cardiac Surgery Approach and an Experimental Study

“…All these results are consistent with previous reports ( Amorim et al, 2014 ; Liu and Yin, 2018 ) and with data obtained from our survey on anesthesiologists. Other studies point out this improvement in terms of “time-to-consciousness” as return of consciousness several minutes faster after reversal with SG compared to NG ( Biricik et al, 2019 ), or “time to recovery” as time to attaining full neuromuscular recovery according to a TOF ratio of > 0.9 from TOF ratio of.25 ( Amorim et al, 2014 ; Claroni et al, 2019 ).…”

Comparison of the Effect of Sugammadex and Pyridostigmine on Postoperative Catheter-Related Bladder Discomfort: A Retrospective Matched Cohort Analysis

“…Among studies comparing the effects of sugammadex and cholinesterase inhibitors, some considered the effects of glycopyrrolate, while others did not [ 1 , 2 , 3 , 22 , 23 , 24 ]. Because we have only been using pyridostigmine, we only compared sugammadex with pyridostigmine in this study.…”